P 25

FREQUENCY OF RESPIRATORY CHLAMYDIOSIS DISSEMINATION AMONG CHILDREN WITH COMPLICATED ANAMNESIS

L.V. Fedchuk, V.P. Fedchuk
Odessa State Medical University, Odessa, Ukraine
Research Center for the Diseases Transferred through Sexual Way, Odessa, Ukraine

The present work was aimed at the exploration of the respiratory chlamydiosis dissemination frequency among children from non-favorable groups of population of the Ukraine.
The antibody (IgM and IgG) to C. trachomatis presence was detected in serum using immunofermentative analysis. The DNA of C. trachomatis, M. hominis and M. pneumonia was registered by polymerase chain reaction (PCR) techniques. The 32 children being in the age range from 1 month to 1 year were chosen from the non-favorable group of Odessa city population and all of them were frequently ill with different pathologies of respiratory tract.
The antibodies to C. trachomatis of IgG class were detected in 14 cases (43.7 %) and IgM in 7 cases (21.9 %) for the titres 1:40 and 1:200, respectively. The DNA of C. trachomatis was found in 15 cases (46.8 %). The DNA of M. hominis and M. pneumonia – in 10 cases (31.25 %) and in 12 cases (37.5 %), respectively. It should be noted that simultaneous detection of DNA of chlamydia and mycoplasma was registered in 9 cases (28.1 %).
We have shown that the respiratory pathology of all the children under examination is not caused by only one infectious agent only. The two-agent (chlamydia and mycoplasma) disease initiation always needs complex treatment which should be directed against the both agents.
Pathology of respiratory tract of early aged children from non-favorable families is caused mainly by one or two-agents disease initiation. In-time made differential diagnostics allow to propose the adequate directed treatment which in turn provides the successful outcome of the case.

P 26

ACUTE BILIARY SEPSIS AT CHOLEDOCHOLITHIASIS

O.A. Dmytryukova, V.V. Khatsko, A.G. Grintsov, M.N. Akhtar, Y.G. Kolkin, N.V. Fominova, A.E. Kuzmenko, I.F. Polulyah
Department of Facultative Surgery, Donetsk Medical State University, Ukraine

Aim: The purpose of our work was to study clinical and diagnostic criteria of acute biliary sepsis (ABS) at choledocholithiasis (CDL) for assignment of optimum treatment.

Materials and methods: For 10 years in clinic were operated 759 patients with CDL.
In 70 (9.2%) cases after complex inspection is revealed ABS. Among patients were 51 women and 19 men in the age of 32 to 80 years. The diagnosis put on the basis of the clinical, biochemical data, biochemical researches of blood, bacteriological analysis of bile and the blood, special methods of research (ultrasonic, endoscopic retrograde cholangiopancreatography, intraoperative cholangiography, fibrocholangioscopy). The control group was made by 10 healthy donors.

Results: In clinical picture of ABS are characteristic symptoms of the common intoxication, hepatic insufficiency and encephalopathy which frequently transfer into polyorganic insufficiency in absence of symptoms of irritation of peritoneum and the not expressed jaundice. Infringement permeability of common bile duct (CBD) was caused CDL, in a combination with stenosis of big duodenal papilla (BDP) in 21 (30%) persons, with chronic pancreatitis in 7 (10%). At bacteriological research of bile is more often (in 36.2%) was allocated bacillus coli, in 56.3 were association of microorganisms. At radical operative treatment were used 3 methods: endoscopic, surgical and combine. The most important element of optimum treatment of ABS are drainage and sanitation of intra and extrahepatic bile ducts, antibacterial therapy before and after operation, intensive infusion therapy, active methods of detoxication, electrophoresis, laprotherapy, vitaminotherapy and antioxidants.

Conclusion: Acute biliary sepsis – serious complication of CDL, demands timely diagnostics and urgent, optimum on volume, operative intervention on a background of intensive therapy. Complex conservative treatment after endoscopic corrections of CDL creates optimum conditions for performance of radical operation.

P 27

CIPROFLOXACIN: EXPERIENCE OF 7 YEARS USING IN RHEUMATOLOGY

B.S. Belov, S.V. Shubin, G.M. Tarasova, S.I. Soldatova, M.M. Urumova, O.L. Belova
Institute of Rheumatology of RAMS, Central Clinical Hospital, Moscow, Russia

The aim of the study was to evaluate the efficacy and tolerability of ciprofloxacin in rheumatic patients. Study included 142 patients (aged 18-65) with different rheumatic diseases. Infection with different localization (lower respiratory tract, genitourinary tract, skin and soft tissues) were indications for ciprofloxacin. Patients with active urogenital chlamydiosis were prescribed ciprofloxacin in maximal day dosages for 28 days with clinical-microbiological control on the 14th and 28th day of the therapy also in 30 and 60 days after the end of the treatment. In all other cases ciprofloxacin was administered in the average day dosage for 7-14 days with clinical-microbiological control before and after the treatment. The therapy of basic disease was not changed and other antibiotics were not used. Recovery from the infection was observed in 184 (84.4%) patients. Simultaneously, positive changes could be observed in the basic disease. Side effects (headache, dizziness, discomfort in epigastrium, nausea, photosensitization, skin rash) observed in 35 (16.1%) patients. All adverse experiences were considered to be related to study medication. Most events were classified as mild to moderate in severity. Therapy was discontinued in 8 (3.7%) patients because of hypersensitivity reactions or increased gastrointestinal side effects. There were no clinical significant interactions of ciprofloxacin with glucocorticoids and/or nonsteroidal anti-inflammatory drugs during this trial. Ciprofloxacin was not associated with QTc – interval prolongation.
Ciprofloxacin is an effective and safe drug for the treatment of different infections in rheumatic patients. Further clinical trials are required to develop optimal regimens of ciprofloxacin therapy to this category of patients.

P 28

COMBINED INTRA-ARTICULAR INJECTIONS OF RIFAMPICIN AND TRIAMCINOLONE ACETONIDE IN RHEUMATOID ARTHRITIS

Y.A. Olyunin, G.G. Zambaltarova, R.M. Balabanova
Institute of Rheumatology of RAMS, Moscow, Russia

Repeated intra-articular injections of rifampicin (RFA) were reported to be effective in the treatment of chronic synovitis in juvenile rheumatoid arthritis. More recently combined local treatment with RFA and triamcinolone hexacetonide provided promising results in rheumatoid arthritis (RA). 34 patients with RA aged 23 to 69 years were included to assess efficacy and safety of combined treatment with RFA and triamcinolone acetonide (TA). Disease duration ranged from 1 to 31 years. All had knee joint synovitis of at least 1month duration. Patients were randomly assigned to receive one of two treatments. 17 knee joints of 17 patients were injected with TA 40 mg in combination with RFA 600 mg. 17 knee joints of 17 control patients were injected with TA 40 mg only. Synovial fluid was aspirated before administration of medications in all cases. Treatment was considered effective when joint pain decreased by at least 50% on 100 mm visual analog scale and effusion disappeared completely. When pain decrease was less prominent and/or effusion could be detected at joint palpation relapse of synovitis was recorded. There was significant decrease of knee joint pain in both groups 3 months after treatment. Synovitis relapsed in 6 of 17 control group patients and only in 1 of 17 patients after combined treatment with TA and RFA (p < 0.05). The results of the present study demonstrate that combined treatment with TA and RFD may provide more prolonged effect than TA alone.

P 29

CLINICAL AND ECG DATES OF DIPHTHERITIC MYOCARDITIS

L. Shostakovich-Koretskaya, P. Khayikin
Dnipropetrovsk Medical Academy, Ukraine

Objective: Study of clinical and ECG peculiarities of Diphtheritic myocarditis (DM) manifestation.

Methods: We have investigated 20 patients with DM (from 3 to 15 years), using clinical observed and ECG monitoring.

Results: DM was observed in patients with toxical (severe) form of diphtheria in 95%. DM appeared at 5-7 days more often (65%), at 10-12 in 30%. 62.5% of patients were not vaccined. The DM had most severe course when antitoxin was used too late (after 3rd day). ECG sings of ischemia were determined in 50.0%, arrhythmia in 15.0%, unspecific changes in 10%. The cardialgia was observed in 18.7%, signs of cardiac insufficiency in 25.0%, cardiomegaly in 37.5%, apex murmur in 50.0%.

Conclusion: DM, as specific complication more often appears in patients who were not vaccined and when antitoxin was used late. The clinical signs of DM are not specific and must be analyzed with dates of ECG monitoring during 5-20 days of disease.

P 30

TREATMENT OF STAPHYLOCOCCAL VENTRICULITIS ASSOCIATED WITH EXTERNAL CSF DRAINS: A PROSPECTIVE RANDOMIZED TRIAL WITH INTRAVENOUS VS INTRAVENTRICULAR VANCOMYCIN THERAPY

B. Pfausler, H. Spiss, R. Beer, E. Schmutzhard
Department of Neurology, University Hospital, Innsbruck, Austria

Objective: Temporary external ventricular drains (EVD) may be complicated by staphylococcal ventriculitis. The limited penetration of Vancomycin (V) into the cerebrospinal fluid is well known; the pharmacodynamics and efficacy of systemically versus intraventricularly administered V has been examined in a prospective study.

Methods: Ten patients with an EVD due to intracranial haemorrhage suffering from a drain-associated ventriculitis (DAV) were randomised in 2 treatment groups. 5 patients, median age 47 years, were treated with 2 g/day V intravenously (q.i.d; group 1) and 5 patients, median age 49 years, with 10 mg V intraventricularly once daily (group 2). Vancomycin-levels (VL) were measured in serum and CSF 6 times a day. The maximum VL in CSF was 1.73 +/- 0.40 µg/mL (mean +/- SD) in group 1 and 565.58 +/- 168.71 µg/mL one hour after V application in group 2. VLs in CSF above the recommended trough level of 5 µg/mL were never reached in group 1, whereas in group 2 VLs were below the trough level (3.74 +/- 0.66 µg/ml) only 21 hours after intraventricular V application. VL in the serum was constant within therapeutical levels in group 1, wheras in group 2 V was in most instances below a measurable concentration. In both groups bacteriological and laboratory CSF clearance could be obtained.

Conclusion: Intraventricular V application is an equally safe and efficacious treatment modality in DAV achieving much higher VLs in the ventricular CSF than by intravenous administration.

P 31

PREVENTION AND TREATMENT OF P. AERUGINOSA INFECTION

V. Tkachenko, A. Tsyganenko, S. Abu Hammid
Kharkov State Medical University (KhSMU), Ukraine

Treatment and prevention of hospital puruloseptic infections (especially Pseudomonas aeruginosa infection) are an urgent problem of modern medicine. Complexity of specific prophylaxis and antibacterial therapy of the above infections requires new approaches for accomplishment of this task. Pseudomonas aeruginosa infection affects persons with immunodeficiencies but mainly patients with thermal burns. The purpose of the present research was to experimentally substantiate the use of liposomal form of Pseudomonas aeruginosa toxoid (LFPAT) for prevention, and gel and cream with chloramphenicol 1% for treatment Pseudomonas aeruginosa burn infection. The use of LFPAT activated immune responses in the organism of the experimental animals; it was manifested by intensification of proliferative and hyperplastic processes in the thymus, spleen, lymph nodes, liver, and with addition of the macrophage-plasmocyte response. But injection of the preparation did not cause any dystrophic and destructive changes in the immunocompetent organs of the experimental animals. LFPAT immunization increased functional ability of nucleus-containing splenic cells after injection of the T-dependent antigen into the mice, normalization in the indices of rosette-forming cells and functional ability (phagocyte count and phagocyte index) of blood neutrophils in the burnt animals.
The composition of new ointment forms (gel and cream with chloramphenicol 1%) is based. In vitro 1% of chloramphenicol (gel and cream) shows pronounced high antibacterial activity. In vivo, both medical forms show pronounced therapeutic effect; they promote elimination of Pseudomonas aeruginosa from wounds and decrease inflammation. In noninfected thermal trauma in laboratory animals application of gel and cream of chloramphenicol reduces transition from the phase of inflammation to the phase of reparation by 3-8 days and prevents infection of the burn wound by opportunistic microflora.

P 32

EVALUATION OF ORSAB (OXOID) - A NEW CHROMOGENIC MEDIUM FOR DETECTION OF MRSA DIRECTLY FROM CLINICAL SPECIMENS

P. Apfalter, O. Assadian, R. Hörler, V. Lindenmann, A. Makristathis, S. Mustafa, A.M. Hirschl
Hygiene-Institute of the University of Vienna, Austria

Background: The purpose of this study was to evaluate a new chromogenic medium, Oxacillin Screen Agar Base (ORSAB; Oxoid, Hampshire, United Kingdom) for the detection of methicillin-resistant Staphylococcus aureus (MRSA) in comparison to our standard procedure.

Methods: 579 swabs from 83 inpatients were randomly streaked onto ORSAB (containing 5.5% NaCl and 2 mg/l oxacillin), phenyl mannitol salt agar plates + 1 µg oxacillin disk (MS-Oxa) and Columbia agar plates supplemented with 5% sheep blood (BA). Swabs were then submerged in brain heart infusion (BHI) containing 6.5% NaCl. All media were examined after 24 and 48 h of incubation at 35°C. S. aureus was identified based on its typical appearance and a positive coagulase test (Pastorex Staph-Plus), oxacillin disk diffusion-test, oxacillin screening agar according to NCCLS guidelines and detection of the mecA gene by means of PCR. If there was growth in BHI only, subculture was performed after 24 or 48 h on ORSAB, MS-Oxa and BA.

Results: 284 swabs (49%) were positive for S. aureus on any medium, of these 236 (from 44 patients) were MRSA. 78 isolates (33%) grew in BHI only, with 37 (16%) and 41 (17%) strains being detected after 24 and 48 h, respectively. After 24 h [48h] sensitivity and specificity for MS-Oxa and ORSAB were 53.8% [65.7%] vs. 50.8% [68.2%] and 92.7% [91.7%] vs. 95.6% [94.5%], respectively. ORSAB and MS-Oxa identified 51% (77/120 strains grew abundantly) and 54% (80/127 strains grew abundantly) of MRSA within 24 h.

Conclusion: The intensive blue colonies on ORSAB facilitate the identification of MRSA. Furthermore, compared to MS-Oxa ORSAB produced fewer false positive results after both 24 and 48 h, but ORSAB did not recover more MRSA within 24 h. Both screening media were able to identify more than 50% of MRSA within 24 h. However, it is not feasible to drop enrichment broths in MRSA-screening protocols since one third of MRSA would have been missed.

P 33

MONTE CARLO ANALYSIS OF GATIFLOXACIN 400 MG DAILY IN HOSPITALIZED PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA

A. Noreddin, D. Hoban, G. Zhanel
University of Manitoba, Medical Microbiology, Winnipeg, Canada

Objective: This work aimed at determining target attainment potential of gatifloxacin (Gati) in specific patient populations such as immuno-competent elderly, young as well as immuno-compromised patients hospitalized with community acquired pneumonia (CAP).

Methods: A previously described population pharmacokinetic (PK) model of fluoroquinolone administration to patients with serious CAP was utilized to simulate Gati PK. The pharmacokinetic simulations and our Canadian susceptibility data on Streptococcus pneumoniae (CROSS-Canadian Respiratory Organism Susceptibility Study) were integrated via Monte Carlo Simulation enabling initiation of the probability of achieving targeted pharmacodynamic outcome (AUC0-24/MIC90 of 30 for S. pneumoniae).

Results: Gatifloxacin displayed a longer half-life in elderly (14.7 h), young (8.9 h) as well as immuno-compromised patients (13 h) compared to the healthy volunteers, (8 h). Elderly, young and immuno-compromised patients with CAP had Free-Drug AUC0-24/MIC90 value of 122.8, 55.8 and 82.8 respectively compared to a value of 54 in case of healthy volunteers. Probability for target attainment against Canadian strains of S. pneumoniae (AUC0-24/MIC90 of 30) when administering gatifloxacin IV 400 mg for 24hr to elderly, young and immuno-compromised patients with CAP was 98.9%, 94.5% and 96.4% respectively compared to 92.8% for young healthy volunteers.

Conclusion: In elderly, young as well as immuno-compromised patients hospitalized with CAP, Gati PK are markedly different than those of healthy volunteers. Higher Gati AUC and t 1/2 values in these patient populations compared to the healthy volunteers may provide better pharmacodynamic parameters (AUC/MIC). However, target attainment analysis showed that Gati could achieve favorable antibacterial effect in all patient population.

P 34

MICROORGANISM ISOLATED FROM ORTHOPAEDIC PATIENTS OF VOLOS-GENERAL HOSPITAL AND THEIR SENSITIVITY

E. Georgopoulou, D. Krikou, D. Kafidas, E. Vlachaki
Orthopaedic Departement, General Hospital of Volos, Greece
Microbiology Lab., General Hospital of Volos, Greece

Aim: To review and analyse the rate of possive cultures from orthopaedic patients, the type of microorganisms grown and their sensitivity during the past year (2002).

Material and methods: Of 2050 patients treated in the orthopaedic departement in 2002, 102 [50 female, 52 male, mean age 56 (7-91)] required microbiological investigation of samples (wound swabs, pus, tissues, articular fluid) due to clinical suspicion of infection. The patients were treated for fractures (n=41), joint arthroplasty (n=23), inflammation (n=17), soft tissue wounds (n=15), surgical debridement (n=6).
The samples were taken from different sites: knee (n=37), ankle and foot (n=15), tibia (n=18), hip (n=25), thigh (n=5), arm and hand (n=3).
Isolation was performed by laboratory standard methods, identification with the API System and sensitivity testing with Agar-diffusion for the following antibiotics: Ampicillin, Amoxicillin+Clavulanic, Oxacillin, Cefaclor, Cefotaxim, Ceftacidime, Ceftriaxon, Ciprofloxacin, Ofloxacin, Gentamicin, Vancomycin, Fusidic acid, Clindamycin and Tazobactam.

Results: Positive cultures were found in 75 (of 102) cases. In 29 of those cases more than one organisms were identified. 27 cultures were negative.
The most frequently isolated pathogens were: Staph. epidermidis (25%), Staph. aureus (23%), Enterococcus (18%), Acinetobacter (9%), Enterobacter (8%), Streptococci (5%), Pseudomonas (4%), E. coli (2.5%), Proteus (2.5%), Klebsiella (2%) and Stenotrophomonas (1%). 80% of the microorganisms were sensitive to most of the tested antibiotics. 12% of the gram-positive and 38% of the gram-negative strains were multiresistant.

Conclusion: There is growing concern about the presence of multiresistant nosocomial, mainly gram-negative, stains in samples from orthopaedic patients in our hospital.

P 35

THE THERAPY OF MENINGOCOCCAL MENINGITIS WITH CEFTRIAXONE

I. Marincu, L. Negrutiu, M. Curescu, L. Alexandrescu, S. Laitin, M. Szilagyi
Clinic of Infectious Diseases, U.M.F. Timisoara, Romania

Introduction: The occurring of the resistant strains to Penicillin, imposed the gradual introduction of the third generation Cephalosporins in the treatment of the bacterial meningitis.

Objective: The study of therapy with Ceftriaxone in acute meningococcal meningitis.

Methods: The authors studied a group of 21 patients who were admitted in the Infectious Diseases Clinic of the ,,Victor Babes” Hospital from Timisoara with meningococcal meningitis. The diagnosis of the bacterial meningitis was based on clinical findings (malaise, fever, headache, stiff neck, vomiting, skin eruption petechial, confusion) and on examination of spinal fluid sample (aspect, pressure, Pandy reaction, PMN leukocytes counts, proteins, clor, glucose and culture on special mediums). All patients were treated with Ceftriaxone (Rocephin – Roche), 4 g/24 hours, iv, during between 8 and 10 days and supportive treatment with AINS, corticotherapy, vitamins, antipyretics.

Results: The antibiograms confirmed the sensibility of the isolated germs to Ceftriaxone. Moreover, 6 strains of Neisseria meningitidis were resistant to Penicillin. On the end of treatment, we declared recovered 21 patients, having only 5 patients presented minor adverse reactions with a fugitive character.

Conclusion: Ceftriaxone, a third generation Cephalosporin, recognized by his large spectrum of action can be used with success in the treatment of meningococcal meningitis.

P 36

PENICILLIN G VS CFSIII IN MENINGOCOCCAL MENINGITIS

M. Hurmuzache, V. Luca, O. Mihoc, D. Teodor, D. Chiselita, D. Timpau
UNIV. MED & PH, Iasi, Romania

Objective: To compare activity of penicillin G vs CFSIII (Ceftriaxone, Cefotaxime) during meningococcal meningitis with/without meningococcemia (MM/MM+MC) and meningococcemia (MC).

Materials and methods: Retrospective study for 10 years (1993-2002) including 215 patients, admitted in Univ. Hosp. of Inf. Dis. Iasi, Romania. By age the group was structured: 0-1 y=49 (22.7%), 1-5 y=79 (36.7%), 5-16 y=52 (24.2%), > 16 y=35 (16.3%); males 113 (52.6%), females 102 (47.4%).
Maximum of incidence was between 1998-2000 (101 cases). Among the total of 215, MM were123 (57.2%)=grA, 63 MM+MC (29.3%)=gr B and MC 29 (13.5%)=gr C. In all 3 groups there were patients treated with Pen G or CFSIII.

Results: Gr A: 89 received Pen G: 86 recovered(R)=96.6%; 2 deaths(D)=2.24%, 1 with sequalae(S)=1.12%. CFS III received 34 with R=32 (94.2%), D=1 (2.94%) and S=1 (2.94%).
In gr B: 42 received Pen G: R=32 (76.2%), D=7 (16.6%), S=3 (7.2%) and 21 received CFSIII: R=19 (90.5%), D=1 (4.7%), S=1 (4.7%).
In gr C: 16 were treated Pen G: R=7 (43.7%), D=8 (50%), S=1 (6.3%) and 13 received CFSIII: R=9 (69.2%), D=4 (30.8%), S=0.
In 119 cases the meningococc was isolated in CSF or blood, only 3 of the strains (all of them type B) had modified sensitivity at Pen G and 1 at Cefotaxime. We noticed there were no significant differences concerning R, D and S in gr A treated Pen G or CFSIII, but in groups B and C the efficiency of CFSIII is clearly superior.

Conclusion: In MM Pen G still remains a very efficient antibiotic, option for CFSIII being obligatory in MM+MC or MC, especially in infants under 5 y, recovering, deaths and sequalae having a significant lower rate in groups B and C treated CFSIII, due probably to a superior activity in vivo of these antibiotics (PBP-linked mechanism).

P 37

INCIDENCE OF SALMONELLOSIS IN THE COUNTY OF TRIKALA

T.K. Galeas, A. Papadopoulos, S. Mylonas, A. Vasiliki Galea, A. Kouloumvaki, A. Rematisios, M. Lemoni, V. Ippa
B’Internal Medicine of Trikala, Microbiology Laboratory, General Hospital of Trikala, Greece

The purpose of the work is to study the incidence of salmonellosis in the county of Trikala the last 30 years.
Material of the study were patients from the emergencies or those admitted in the internal medicine clinics of the hospital. Diagnosis of salmonellosis was confirmed by the clinical symptoms (fever, abdominal pain, diarrhea), widal test, faeces culture.

Results: In a period of 30 years we wrote down 254 cases of salmonellosis. In detail 1969-73: 49, 1974-79: 45, 1980-84: 8, 1985-89: 8, 1990-94: 35, 1998-2002: 109. There was an interruption of 1995-97 with no documents. We observed a progressive decrease in the 1974-1989 period. From 1990 till today there has been a rising course.
In conclusion mass production due to excess demand for products (such as poultry, eggs, ice cream responsible for the transmission of salmonellosis) makes people ignore basic rules of health protection all through the scale from production to consumption despite the fact we have all the means to minimize the disease.

P 38

FOURNIER’S GANGRENE: REPORT OF 10 PATIENTS AND REVIEW OF THE LITERATURE

C. Lioupis, J.E. Georgopoulou, D. Koutarelos, P.A. Katsafourou, J. Parker, L. Maurogiannis, A. Lioupis
Department of Surgery, General Hospital of Volos, Greece

Fournier’s gangrene is a disease characterized by necrotizing fasciitis of the perineal and genital region, resulting from synergistic polymicrobic infection. We present 10 patients with Fournier’s gangrene admitted within a 9-year period.

Material and methods: Ten patients, eight males and two females, were treated at the Department of Surgery of the General Hospital of Volos, from 1994 to 2003. The cases were then evaluated for similarities in age, associated or predisposing conditions, site of primary infection or portal of vacterial entry, results of cultures, therapeutic means, length of hospitalization and outcome of treatment.

Results: The patients ranged in age from 33 to 88 years, and most of them were middle-aged (mean 63 years). Associated debilitating diseases were present in five patients and included three with diabetes mellitus, one with paraparesis and one with Down’s syndrome. Aggressive surgical debridement was undertaken in all cases, on a daily basis for the initial interval. The hospital stay ranged from 24 to 90 days. Cultures showed polymicrobial flora. A diverting transverse colostomy was performed in one patient. One patient required a unilateral orchidectomy. Eight patients were discharged from the hospital with their lesions healed or granulating. Two patients underwent coverage with split-thickness grafts or myocutaneous flaps. Two patients died, one male and one female. Both of them died of overwhelming sepsis.

Conclusion: The fact that two patients died despite aggressive treatment indicates the lethal nature of the disease. The fundamental problem may be reduced immunity. Delay in treatment is associated with increased mortality rate. Wound healing by delayed closure is feasible in many cases. Once the infection and necrosis have subsided, tissues show a remarkable ability to regenerate and heal. Moreover, skin movement in combination with split-thickness skin grafts may have excellent results.